Nursing Elites

1. A client who underwent lobectomy 24 hours ago has not had any chest tube drainage for the past hour. What should the nurse do first?

• A. Contacts the physician
• B. Checks for kinks in the drainage system
• C. Checks the client’s blood pressure and heart rate
• D. Connects a new drainage system to the client’s chest tube

Correct answer: B

Rationale: When a chest tube is not draining, the nurse's initial action should be to check for kinks or clots in the chest drainage system. This step helps to ensure the patency of the system and allows for proper drainage. Checking the client's blood pressure and heart rate is important but not the priority when addressing a lack of chest tube drainage. Contacting the physician is warranted if signs of respiratory distress or mediastinal shift are observed after ruling out kinks or clots. Connecting a new drainage system is done when the fluid chamber is full, following a specific procedure to maintain a closed system and prevent complications.

2. A client with polycystic kidney disease (PKD is being assessed by a nurse. Which assessment finding should prompt the nurse to immediately contact the healthcare provider?

• A. Flank pain
• B. Periorbital edema
• C. Bloody and cloudy urine
• D. Enlarged abdomen

Correct answer: B

Rationale: Periorbital edema would not typically be associated with polycystic kidney disease (PKD) and could indicate other underlying issues that require immediate attention. Flank pain and an enlarged abdomen are common findings in PKD due to kidney enlargement and displacement of other organs. Bloody or cloudy urine can result from cyst rupture or infection, which are expected in PKD. Therefore, periorbital edema is the most alarming finding in this scenario and warrants prompt notification of the healthcare provider.

3. A patient with a diagnosis of Cushing's syndrome is likely to exhibit which of the following symptoms?

• A. Hyperpigmentation.
• B. Moon face.
• C. Hypotension.
• D. Hypertension.

Correct answer: B

Rationale: The correct answer is B: Moon face. Cushing's syndrome is characterized by excess cortisol levels, leading to the distinctive round and full face known as moon face. Hyperpigmentation (choice A) may occur due to increased ACTH levels, but it is not a hallmark symptom like moon face. Hypotension (choice C) is less common in Cushing's syndrome as cortisol typically leads to hypertension (choice D) due to its effects on blood pressure regulation.

4. A confused client with pneumonia is admitted with an indwelling catheter in place. During interdisciplinary rounds the following day, which question should the nurse ask the primary health care provider?

• A. Do you want daily weights on this client?
• B. Will the client be able to return home?
• C. Can we discontinue the indwelling catheter?
• D. Should we get another chest x-ray today?

Correct answer: C

Rationale: An indwelling catheter dramatically increases the risks of urinary tract infection and urosepsis. Nursing staff should ensure that catheters are left in place only as long as they are medically needed. The nurse should inquire about removing the catheter. All other questions might be appropriate, but because of client safety, this question takes priority.

5. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse’s priority action?

• A. Calculate the mean arterial pressure (MAP).
• B. Ask for insertion of a pulmonary artery catheter.
• C. Take the client’s pulse.
• D. Slow down the normal saline infusion.

Correct answer: D

Rationale: The nurse should recognize that the client may be developing fluid overload and respiratory distress due to the rapid normal saline infusion. The priority action is to slow down the infusion to prevent worsening respiratory distress and potential fluid overload. While calculating the mean arterial pressure (MAP) is important to assess perfusion, addressing the immediate respiratory distress takes precedence. Inserting a pulmonary artery catheter would provide detailed hemodynamic information but is not the initial step in managing acute respiratory distress. Monitoring vital signs, including the client's pulse, is crucial after adjusting the intravenous infusion to ensure a safe response to the intervention.

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